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Cytotoxic edema in neuro-Behcet's disease ?
Isha Shrestha1, Tomohiko Ohshita, Hiromitsu Naka
1Departmant of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima. pshisha2001@yahoo.com
Internal Medicine (Tokyo, Japan)
|December 2, 2008
Summary
This case highlights Behcet's disease presenting with neurological symptoms like dysarthria and hemiparesis. Atypical brain imaging findings resolved with steroid treatment, showing the varied radiological presentation of neuro-Behcet's disease.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Behcet's disease is a multisystem inflammatory disorder.
- Neuro-Behcet's disease (NB) can manifest with diverse neurological symptoms.
- Brainstem involvement in NB is less common but significant.
Observation:
- A 52-year-old woman with Behcet's disease presented with acute dysarthria and right hemiparesis.
- MRI revealed a left pontine lesion with characteristic T2 hyperintensity and restricted diffusion (decreased ADC).
- These findings suggested cytotoxic edema, possibly from excitotoxic injury.
Findings:
- The pontine lesion showed a significant decrease in apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI).
- This DWI/ADC pattern is atypical for common NB lesions but indicative of cytotoxic edema.
- Complete radiological resolution was observed after treatment with prednisolone.
Implications:
- This case underscores the broad spectrum of neuroimaging findings in NB.
- Atypical DWI/ADC patterns should be considered in the differential diagnosis of NB.
- Early recognition and treatment of NB are crucial for favorable outcomes.
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